PROTON THERAPY IS DEALT BLOW

But Scripps says new center’s viability not challenged by Blue Shield ruling

Scripps Health said Thursday that a decision by Blue Shield of California to stop covering proton beam therapy for prostate cancer will not challenge the financial viability of a new $230 million proton therapy center set to open in October.

On Thursday, Blue Shield confirmed that it has notified doctors that it will stop paying for the treatment on Oct. 28. The insurance company cited cost effectiveness as the main reason.

In recent years, several research papers have questioned the utility and cost effectiveness of proton treatment, which uses a massive linear accelerator called a cyclotron to shoot charged particles into cancerous tumors. The studies have found that, in general, a cheaper technology that uses converged X-ray beams instead of a beam of protons is just as effective at killing tumors and is much less expensive.

One study published in late 2012 by Yale University found that Medicare paid $32,000 for proton treatment compared to only $19,000 for the equivalent X-ray-based treatment.

Scripps announced in 2010 that it would be the first health system in the region, and one of 12 in the nation, to offer proton therapy, which it billed as offering a new range of options for San Diego County residents. It partnered with a private company, San Diego-based Advanced Particle Therapy, to build the facility on a seven-acre plot in Mira Mesa. UC San Diego Health System briefly considered building its own proton accelerator but downsized its plans in 2012.

Dr. Carl Rossi, medical director of the Scripps Proton Therapy Center, said prostate treatments are expected to make up about 40 percent of the center’s patient volume, which is expected eventually to hit 2,400 per year.

He agreed that X-ray-based technology kills tumors just as dead as protons do. But he said the latest studies fail to take into account that proton technology does much less damage to surrounding tissue. That damage, he said, causes an increased risk of additional cancers in tissue that radiation passes through.

“It’s quite clear that the biggest factor in getting a second cancer from radiation is not just the dose (strength) but also the amount of tissue that ends up getting treated,” Rossi said.

He said proton therapy is useful in treating tumors in other organs, including the breast, lung and pancreas, adding that, in some cases, using protons instead of X-rays can be cheaper because fewer sessions are required.

But some aren’t buying that explanation and are citing huge investments in proton technology as a prime example of the arms race in health care that is pushing the cost of treatment ever higher, often without better efficacy for the patient.

In a Los Angeles Times story Thursday, Cary Gross, a researcher at the Yale School of Medicine, called proton “the perfect example of all that is wrong with our health care system.”

“The rush to adopt proton beam is far outpacing the amount of evidence to support its use,” he said.

Rossi said that Scripps plans to consider all technologies on a case-by-case basis and make a recommendation to patients based on whether X-ray offers a 10 percent or less chance of injury to surrounding organs.

“We’ll discuss the pros and cons with each patient. What’s the pro of proton? It will treat less tissue. What’s the con? It will probably cost more,” Rossi said.

Chris Van Gorder, Scripps’ chief executive, said the project is not likely to become a financial burden for the health system. It is fully funded by Advanced Particle Therapy; Scripps will simply run the center, he said.